12070139 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 18920 FORGE DR CONTRACTOR:THERMA CORP PERMIT NO: 12070139
OWNER'S NAME: APPLE INC 1601 LAS PLUMAS AVE DATE ISSUED:02/21/2013
OWNER'S PHONE: 4089961010 SAN JOSE,CA 95133 PHONE NO:(408)347-3400
el LICENSED CONTRACTOR'S DECLARAT ON JOB DESCRIPTION: RESIDENTIALD COMMERCIALQ-
License Class Lic.# APPLE-RM 345, INSTALL NEW EXHAUST SYSTEM TO
Contractor Date
I _/3 SUPPORT NEW FUME HOOD
I.hereby affirm that I am licensed under the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations:
1 have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$20000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this APN Number:31609030.18920 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
1 certify that 1 have read this application and state that-the above information is PERMIT EXPIRES IF WORK IS NOT STARTED`.
correct.1 agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F 'A LED INSPECTION.
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the
granting of thi ermit. Additionally,the applicant understands and will comply is Date:
' l
with all non- ot source reg per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
Signature Date All roofs shall be inspected prior to any roofing material being installed:If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for one of Signature of Applicant Date:
the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. 1 will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(x)should 1 store or handle hazardous
I have and wili maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,S ti ns 255 ,25�, nd 5534.
Section`3700 of the Labor Code,for the performance of the work for which this
permit is issued. Owner or authorized agent: Date.
I certify that in the performance of the work for which this permit is issued,I shall �Cr
not employ any person in any manner so as to become subject to the Worker's l
Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY
become subject to the Worker's Compensationprovisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
1 certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construetion,and hereby authorize representatives of this city to enter
upon the above mentioned property for-inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilitics,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records,
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
FEE ESTIMATOR- BUILDING DIVISION
ADDRESS: 18920 forge dr. DATE: 07/17/2012 REVIEWED BY: bobs.
APN: BP#: A-ZO�7L, /3 VALUATION: 1$20,000
'PERM IT TYPE: Mechanical Permit PLAN CHECK TYPE: Alteration/Addition / Repair
PRIMARY PENTAMATION
USE: Commercial Building PERMIT TYPE: 1CMAP
WORK install new exhausts stem to support new fume hood.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Hood, Mech. Exhaust 1MCHOOD 1 # $133
TOTALS: $133.00
Mech. Plan Check 4.0 1 his $532.00 Phrnib. Plan Check Elec. Plan(:heck
I MECPLNC Mech. Permit Fee: I MPERMIT Plumb. Permit Fee: Flec, Permir Fee:
Other Mech. Insp. hrs $45.ao Otlre r Plumb InsOther Elec. Insp.
0.0 Ll
AInch. Insp. IPhuub, hap, Fee: Flec•. Insp.f'ee
NOTE: This estimate does not include fees due to other Departments(i.e.Planning,Public Works, Fire,Sanitary Sewer District,School
Districl,etc). These ees are based on the relimina information available and are only an estimate. Contact the De 1 or addn't info.
FEE ITEMS (Fee Resolution 11-053 Eft: 711111) FEE QTY/FEE MISC ITEMS
Plein Check Fee:
Suppl. PC Fee
PME Plan Check: $532.00
Permit Fee:
Suppl. Insp Fee
PME Unit Fee: $133.00
PME Permit Fee: $45.00
Consn•uclion Tox.- 77
Administrative Fee: [ADMIN $42.00
Work Without Permit? ® Yes E) No $0.00
Advanced Planning Fees:
Travel Documentation Fee: ITRA VDOC $45.00
i
Strom Motion Fee: IBSEISMICO $4 Select an Administrative Item
1110 Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $802.20 $0.00 TOTAL FEE: $802.20
Revised: 07/01/2012